Review estimates brain infection in about 1 in 4 people with seizures
A pooled analysis found that neurocysticercosis was present in an estimated 25.2% of people with epileptic seizures, but results varied by setting and study methods.
High evidenceReviewSome caution advised
Medical disclaimer: This article summarizes research findings and is for informational purposes only. It is not medical advice.
Editorial illustration — not from the study.
The review searched 20 databases and combined findings from studies in regions where neurocysticercosis is endemic. The researchers included studies that used brain imaging, biopsy, or autopsy to identify the infection and excluded studies considered to have a high level of selection bias.
The pooled estimate was 25.2%, with a 95% Bayesian credible interval of 19.5% to 32.2%. The estimated proportion was lower in studies that did not clearly define neurocysticercosis or epileptic seizures. It also declined in Africa, the Americas, and Southeast Asia when studies from June 2008 to May 2023 were compared with those from January 1990 to May 2008, although the researchers said it is uncertain whether this represents a real decline or changes in research methods and study populations.
What the review examined
This was a systematic review and Bayesian meta-analysis of human studies examining the proportion of people with epileptic seizures who also had neurocysticercosis. The researchers searched 20 electronic databases for studies published from January 1990 through May 9, 2023. Of 16,202 records screened, 77 studies met the inclusion criteria. Thirty-five studies included both sexes and all age groups and used clear definitions of seizures and neurocysticercosis. Diagnosis had to be based on neuroimaging, biopsy, or autopsy. The review assessed study quality using a standard checklist for prevalence studies.
What the review concluded
In the studies with clear case definitions, the pooled estimated proportion of neurocysticercosis among people with epileptic seizures was 25.2%, with a 95% Bayesian credible interval of 19.5% to 32.2%. Results differed substantially between studies, indicating fairly high heterogeneity. Studies with unclear definitions reported considerably lower proportions, which the authors said may reflect misclassification. The estimated proportion did not vary by sex or age in the analysis. It was lower in studies from June 2008 through May 2023 than in studies from January 1990 through May 2008 across Africa, the Americas, and Southeast Asia. These findings describe proportions and associations across studies; they do not establish why the estimates changed or show that neurocysticercosis caused seizures in every affected person.
Who this may apply to
These findings may be most relevant to populations with epileptic seizures in regions where neurocysticercosis is endemic and where diagnosis is assessed with methods similar to those used in the included studies. They should not be assumed to represent all people with seizures, all countries, or an individual person's likelihood of having the infection. The review does not establish that the 25.2% estimate applies uniformly across settings, and it does not provide treatment or diagnostic advice.
Why it matters
The findings provide an updated estimate for researchers assessing the burden of neurocysticercosis among people with epileptic seizures, particularly in endemic regions. They also show why estimates can change when researchers use different definitions, study populations, or diagnostic technologies. The result is a population-level estimate, not a diagnosis or individual risk estimate, and it may not apply to places or groups unlike those represented in the included studies.
Limitations & evidence assessment
The studies differed substantially in their settings, participants, definitions, and diagnostic methods, which limits how broadly the pooled estimate can be applied. The lower estimates from studies with unclear definitions suggest that misclassification may have affected some results. Because this review combined existing studies rather than conducting a new standardized investigation, it could not determine whether the reported decline over time was real or instead reflected changes in case definitions, study populations, imaging technology, or other causes of seizures. The abstract does not provide enough information to judge the detailed quality or size of every included study, and pooled estimates can be affected by differences among the underlying studies.
Why this evidence level: Meta-analysis pooling multiple studies sits at the top of common evidence hierarchies.
Evidence levels are editorial estimates derived from study metadata — they are not clinical appraisals.
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